Individual
ANGEL M. RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6541 WEBSTER RD, ORCHARD PARK, NY 14127-1920
(716) 667-7031
(716) 667-7034
Mailing address
6541 WEBSTER RD, ORCHARD PARK, NY 14127-1920
(716) 667-7031
(716) 667-7034
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11656-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020246901
UNIVERA
NY
01
—
000511671007
BLUE CROSS & BLUE SHIELD
NY
01
—
6105576
INDEPENDENT HEALTH
NM
Enumeration date
07/12/2006
Last updated
12/05/2011
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